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Background: The Endoscopic Surgical Skill Qualification System (ESSQS) in Japan evaluates the surgical skills required for laparoscopic surgery as an operator as well as a supervisor. This study aimed to demonstrate the benefits of an ESSQS-certified surgeon's participation in laparoscopic rectal resections as a supervisor (assistant or advisor). Methods: We retrospectively reviewed laparoscopic resection results for cStage II and III rectal cancer performed at 56 Japanese hospitals between 2014 and 2016. We used propensity score matching to generate paired cohorts with or without an ESSQScertified supervisor at a one-to-one ratio. The impact of ESSQS-certified supervisors' participation on short-term outcomes was assessed. In the matched cohort, multivariable logistic regression analysis and multivariable regression analysis of postoperative complication rate and intraoperative blood loss were performed to further mitigate the impact of pathological factors. Results: Two groups (n = 399 each) with or without an ESSQS-certified supervisor were well matched by clinical factors. The group with an ESSQS-certified supervisor had lower blood loss (68 mL vs. 98 mL, P = 0.036) and a lower incidence of severe morbidities of Clavien- Dindo grade ≥IIIa (8.0% vs. 13.3%, P = 0.016). Multivariable logistic regression analysis and multivariable regression analysis confirmed that the attendance of ESSQS-certified supervisors reduced postoperative complication occurrence (adjusted odds ratio: 2.28, 95% confidence interval: 1.38 -- 3.80, P = 0.001) and intraoperative blood loss (estimated difference: -15.7 mL, P = 0.016). Conclusion: This study demonstrated the educational benefits of ESSQS-certified supervisors, including assistants and advisors, evidenced by their superior short-term outcomes. [ABSTRACT FROM AUTHOR]

Objective: For patients with colorectal cancer, lymph node metastasis is a very important factor for prognostic and treatment determinations. Fluorine-18 fludeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) is among the useful tools for detecting lymph node metastasis. Recently, a new 18F-FDG-PET/CT reconstruction technique for improving spatial resolution and signal-to-noise ratios, point spread function (PSF), has become available. We assessed the effect of PSF reconstruction on standardized uptake values and its diagnostic accuracy for lymph node staging in patients with colorectal cancer. Methods: We retrospectively analysed records from patients with colorectal cancer who underwent 18F-FDG-PET/CT for pre-operative staging. All positron emission tomography CT (PET/CT) examinations were reconstructed using ordered subset expectation maximization (OSEM) and OSEM + PSF. We compared sensitivities, specificities, positive-predictive values (PPVs), negative-predictive values (NPVs) and accuracies of conventional PET/CT (reconstructed with OSEM) and PSF-PET/CT (reconstructed with OSEM + PSF) for identifying lymph node metastases. We also analysed the diagnostic confidence level on a 5-point scale. Results: With conventional PET/CT, the sensitivity, specificity, PPV, NPV and accuracy were 53.1%, 99.1%, 94.4%, 88.3% and 89.1%, respectively. With PSF PET/CT, the corresponding values were 65.6%, 99.1%, 95.4%, 91.2% and 91.8%, respectively. Conventional PET/CT and PSF PET/CT did not differ significantly in terms of N-stage definition (p = 0.125). However, the diagnostic confidence level of PSF PET/CT was significantly higher than that of conventional PET/CT (p < 0.01). Conclusion: PSF reconstruction might slightly increase sensitivity without impairing specificity. Moreover, this technique is expected to facilitate more confident radiological decisions when compared with conventional PET/CT. Advance in knowledge: This study demonstrates the clinical effectiveness of PSF PET/CT for lymph node staging in colorectal cancer. [ABSTRACT FROM AUTHOR]